Delays in referral from primary care are associated with a worse survival in patients with esophagogastric cancer

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Title: Delays in referral from primary care are associated with a worse survival in patients with esophagogastric cancer
Authors: Arhi, CS
Markar, S
Burns, EM
Bouras, G
Bottle, A
Hanna, G
Aylin, P
Ziprin, P
Darzi, A
Item Type: Journal Article
Abstract: NICE referral guidelines for suspected cancer were introduced to improve prognosis by reducing referral delays. However, over 20% of patients with esophagogastric cancer experience three or more consultations before referral. In this retrospective cohort study, we hypothesize that such a delay is associated with a worse survival compared with patients referred earlier. By utilizing Clinical Practice Research Datalink, a national primary care linked database, the first presentation, referral date, a number of consultations before referral and stage for esophagogastric cancer patients were determined. The risk of a referral after one or two consultations compared with three or more consultations was calculated for age and the presence of symptom fulfilling the NICE criteria. The risk of death according to the number of consultations before referral was determined, while accounting for stage and surgical management. 1307 patients were included. Patients referred after one (HR 0.80 95% CI 0.68-0.93 p = 0.005) or two consultations (HR 0.81 95% CI 0.67-0.98 p = 0.034) demonstrated significantly improved prognosis compared with those referred later. The risk of death was also lower for patients who underwent a resection, were younger or had an earlier stage at diagnosis. Those presenting with a symptom fulfilling the NICE criteria (OR 0.27 95% CI 0.21-0.35 p < 0.0001) were more likely to be referred earlier. This is the first study to demonstrate an association between a delay in referral and worse prognosis in esophagogastric patients. These findings should prompt further research to reduce primary care delays.
Issue Date: 1-Mar-2019
Date of Acceptance: 1-Mar-2019
ISSN: 1120-8694
Publisher: Oxford University Press (OUP)
Journal / Book Title: Diseases of the Esophagus
Copyright Statement: ©The Author(s) 2019. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus.All rights reserved. For permissions, please This is a pre-copy-editing, author-produced version of an article accepted for publication in Diseases of the Esophagus following peer review. The definitive publisher-authenticated version is available online at:
Sponsor/Funder: Imperial College Healthcare NHS Trust
Imperial College Healthcare NHS Trust
Funder's Grant Number: RDOTH 79560
Keywords: esophagogastric cancer
primary care
referral delays
1103 Clinical Sciences
Gastroenterology & Hepatology
Publication Status: Published online
Conference Place: United States
Embargo Date: 2020-03-01
Online Publication Date: 2019-03-01
Appears in Collections:Division of Surgery
Epidemiology, Public Health and Primary Care

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